Arteriovenous Fistula Creation Using the Optiflow Vascular Anastomosis Device: A First in Man Pilot Study

Manson, Roberto J.; Ebner, Adrián; Gallo, Santiago; Chemla, Eric S.; Mantell, Mark P.; Deaton, David N.; Roy‐Chaudhury, Prabir

doi:10.1111/j.1525-139x.2012.01062.x

Cited by 24 publications

(20 citation statements)

References 9 publications

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“…Applying local interventions which reduce vascular injury, improve shear stress‐induced vasodilation, promote outward remodeling and inhibit neointimal hyperplasia formation may be more innovative and effective. Such interventions include the use of new surgical techniques to alter wall shear stress, endovascular access creation, far infrared therapy, paclitaxel‐coated balloon angioplasty, and perivascular application of recombinant elastase, endothelial loaded gel foam wrap (Vascugel) or antiproliferative agents such as sirolimus (Coll‐R) . Table provides an overview of mode of action and expected outcomes of these local and novel interventions that predominantly prevent vascular injury, modulate the response to vascular injury and/or promote outward remodeling rather than targeting thrombosis prevention.…”

Section: Novel and Future Treatment Strategiesmentioning

confidence: 99%

“…| 253 neointimal hyperplasia formation may be more innovative and effective. Such interventions include the use of new surgical techniques to alter wall shear stress,96 endovascular access creation, 97 far infrared therapy, 98,99 paclitaxel-coated balloon angioplasty, 100,101 and perivascular application of recombinant elastase, 102,103 endothelial loaded gel foam wrap (Vascugel)…”

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confidence: 99%

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The pathogenesis of hemodialysis vascular access failure and systemic therapies for its prevention: Optimism unfulfilled

Viecelli

Mori

Roy‐Chaudhury³

et al. 2017

Seminars in Dialysis

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In patients receiving hemodialysis, the provision of safe and effective vascular access using an arteriovenous fistula or graft is regarded as a critical priority by patients and health professionals. Vascular access failure is associated with morbidity and mortality, such that strategies to prevent these outcomes are essential. Inadequate vascular remodeling and neointimal hyperplasia resulting in stenosis and frequently thrombosis are critical to the pathogenesis of access failure. Systemic medical therapies with pleiotropic effects including antiplatelet agents, omega-3 polyunsaturated fatty acids (fish oils), statins, and inhibitors of the renin-angiotensin-aldosterone system (RAAS) may reduce vascular access failure by promoting vascular access maturation and reducing stenosis and thrombosis through antiproliferative, antiaggregatory, anti-inflammatory and vasodilatory effects. Despite such promise, the results of retrospective analyses and randomized controlled trials of these agents on arteriovenous fistula and graft outcomes have been mixed. This review describes the current understanding of the pathogenesis of arteriovenous fistula and graft failure, the biological effects of antiplatelet agents, fish oil supplementation, RAAS blockers and statins that may be beneficial in improving vascular access survival, results from clinical trials that have investigated the effect of these agents on arteriovenous fistula and graft outcomes, and it explores future therapeutic approaches combining these agents with novel treatment strategies.

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Section: Novel and Future Treatment Strategiesmentioning

confidence: 99%

mentioning

confidence: 99%

The pathogenesis of hemodialysis vascular access failure and systemic therapies for its prevention: Optimism unfulfilled

Viecelli

Mori

Roy‐Chaudhury³

et al. 2017

Seminars in Dialysis

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“…The Optiflow™ device has been the most studied; in a human pilot study safety and technical success were achieved in 10 patients [226]. A follow up study of 41 patients showed unassisted patency of 78% at 90 days with no device related adverse events [227].…”

Section: Future Approaches To Treatmentmentioning

confidence: 99%

Future research directions to improve fistula maturation and reduce access failure

Patel

Hänisch

et al. 2016

Seminars in Vascular Surgery

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With the increasing prevalence of end stage renal disease there is a growing need for hemodialysis. Arteriovenous fistulae (AVF) are the preferred type of vascular access for hemodialysis but maturation and failure continue to present significant barriers to successful fistula use. AVF maturation integrates outward remodeling with vessel wall thickening in response to drastic hemodynamic changes, in the setting of uremia, systemic inflammation, oxidative stress and preexistent vascular pathology. AVF can fail due to both failure to mature adequately to support hemodialysis, as well as development of neointimal hyperplasia (NIH) that narrows the AVF lumen, typically near the fistula anastomosis. Failure due to NIH involves vascular cell activation and migration and extracellular matrix remodeling with complex interactions of growth factors, adhesion molecules, inflammatory mediators, and chemokines, all of which result in maladaptive remodeling. Different strategies have been proposed to prevent and treat AVF failure, based on current understanding of the modes and pathology of access failure; these approaches range from appropriate patient selection and use of alternative surgical strategies for fistula creation, to the use of novel interventional techniques or drugs to treat failing fistulae. Effective treatments to prevent or treat AVF failure requires a multidisciplinary approach involving nephrologists, vascular surgeons and interventional radiologists, allowing careful patient selection and the use of tailored systemic or localized interventions to improve patient-specific outcomes. This review provides contemporary information on the underlying mechanisms of AVF maturation and failure and discusses the broad spectrum of options that can be tailored for specific therapy.

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“…Optiflow Anastomotic Connector. This is a sutureless anastomotic connector being developed primarily for AVF creation, which also has the potential to be used for creating a graft-vein anastomosis (93). In addition to reducing surgical time and to some extent leveling the playing field with regard to surgical skill, the ''Optiflow'' connector may favorably alter the anatomical configuration at the graft-vein anastomosis and improve the hemodynamic shear stress profile at this site ( Fig.…”

Section: Special Devices and Bioengineered Vesselsmentioning

confidence: 99%

Back to the Future: How Biology and Technology Could Change the Role of PTFE Grafts in Vascular Access Management

Roy‐Chaudhury

El-Khatib

Campos-Naciff

et al. 2012

Seminars in Dialysis

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Although the arteriovenous fistula (AVF) is the preferred mode of dialysis vascular access, AVF maturation failure remains a huge clinical problem, often resulting in a prolonged duration of use of tunneled dialysis catheters. In contrast, polytetrafluoroethylene (PTFE) grafts do not suffer from early failure, but have significant problems with later stenosis and thrombosis. This review will initially summarize the pathology and pathogenesis of PTFE graft dysfunction and will then use this as a basis for describing some novel therapies, which may have the potential to reduce PTFE graft dysfunction. Finally, we will emphasize that the introduction of such therapies could be an important first step toward individualizing overall vascular access care.

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Arteriovenous Fistula Creation Using the Optiflow Vascular Anastomosis Device: A First in Man Pilot Study

Cited by 24 publications

References 9 publications

The pathogenesis of hemodialysis vascular access failure and systemic therapies for its prevention: Optimism unfulfilled

The pathogenesis of hemodialysis vascular access failure and systemic therapies for its prevention: Optimism unfulfilled

Future research directions to improve fistula maturation and reduce access failure

Back to the Future: How Biology and Technology Could Change the Role of PTFE Grafts in Vascular Access Management

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